|
INCISION OF TENDON & MUSCLE(P
|
Professional
|
Both
|
$1,620.00
|
|
|
Service Code
|
HCPCS 23405
|
| Hospital Charge Code |
761P0455
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$458.82 |
| Max. Negotiated Rate |
$1,015.82 |
| Rate for Payer: Aetna Commercial |
$928.11
|
| Rate for Payer: Ambetter Exchange |
$584.91
|
| Rate for Payer: Anthem Medicaid |
$458.82
|
| Rate for Payer: Buckeye Individual/Medicaid |
$584.91
|
| Rate for Payer: Buckeye Medicare Advantage |
$584.91
|
| Rate for Payer: CareSource Just4Me Medicare |
$701.89
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna Commercial |
$1,015.82
|
| Rate for Payer: Healthspan PPO |
$840.67
|
| Rate for Payer: Humana Medicaid |
$458.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$777.07
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$584.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.91
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$468.00
|
| Rate for Payer: Molina Healthcare Passport |
$458.82
|
| Rate for Payer: Multiplan PHCS |
$972.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$760.38
|
| Rate for Payer: UHCCP Medicaid |
$567.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$463.41
|
| Rate for Payer: Wellcare Medicare Advantage |
$584.91
|
|
|
INCISION OF TENDON SHEATH
|
Professional
|
Both
|
$776.00
|
|
|
Service Code
|
HCPCS 25000
|
| Hospital Charge Code |
76100564
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.64 |
| Max. Negotiated Rate |
$641.66 |
| Rate for Payer: Aetna Commercial |
$491.42
|
| Rate for Payer: Ambetter Exchange |
$330.78
|
| Rate for Payer: Anthem Medicaid |
$214.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$330.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$330.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$396.94
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cigna Commercial |
$641.66
|
| Rate for Payer: Healthspan PPO |
$445.12
|
| Rate for Payer: Humana Medicaid |
$214.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$417.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$330.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.93
|
| Rate for Payer: Molina Healthcare Passport |
$214.64
|
| Rate for Payer: Multiplan PHCS |
$465.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$430.01
|
| Rate for Payer: UHCCP Medicaid |
$271.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$330.78
|
|
|
INCISION OF TENDON SHEATH
|
Facility
|
OP
|
$776.00
|
|
|
Service Code
|
HCPCS 25000
|
| Hospital Charge Code |
76100564
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$266.87 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$597.52
|
| Rate for Payer: Anthem Medicaid |
$266.87
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$605.28
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cigna Commercial |
$644.08
|
| Rate for Payer: First Health Commercial |
$737.20
|
| Rate for Payer: Humana Commercial |
$659.60
|
| Rate for Payer: Humana KY Medicaid |
$266.87
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$269.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$636.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$272.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.88
|
| Rate for Payer: Ohio Health Group HMO |
$582.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$675.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$535.44
|
| Rate for Payer: PHCS Commercial |
$744.96
|
| Rate for Payer: United Healthcare All Payer |
$682.88
|
|
|
INCISION OF TENDON SHEATH
|
Facility
|
IP
|
$776.00
|
|
|
Service Code
|
HCPCS 25000
|
| Hospital Charge Code |
76100564
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$232.80 |
| Max. Negotiated Rate |
$744.96 |
| Rate for Payer: Aetna Commercial |
$597.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$605.28
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cigna Commercial |
$644.08
|
| Rate for Payer: First Health Commercial |
$737.20
|
| Rate for Payer: Humana Commercial |
$659.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$636.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$572.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$232.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$682.88
|
| Rate for Payer: Ohio Health Group HMO |
$582.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$675.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$535.44
|
| Rate for Payer: PHCS Commercial |
$744.96
|
| Rate for Payer: United Healthcare All Payer |
$682.88
|
|
|
INCISION OF TENDON SHEATH(P
|
Professional
|
Both
|
$776.00
|
|
|
Service Code
|
HCPCS 25000
|
| Hospital Charge Code |
761P0564
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$214.64 |
| Max. Negotiated Rate |
$641.66 |
| Rate for Payer: Aetna Commercial |
$491.42
|
| Rate for Payer: Ambetter Exchange |
$330.78
|
| Rate for Payer: Anthem Medicaid |
$214.64
|
| Rate for Payer: Buckeye Individual/Medicaid |
$330.78
|
| Rate for Payer: Buckeye Medicare Advantage |
$330.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$396.94
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cigna Commercial |
$641.66
|
| Rate for Payer: Healthspan PPO |
$445.12
|
| Rate for Payer: Humana Medicaid |
$214.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$417.36
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$330.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$330.78
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$218.93
|
| Rate for Payer: Molina Healthcare Passport |
$214.64
|
| Rate for Payer: Multiplan PHCS |
$465.60
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$430.01
|
| Rate for Payer: UHCCP Medicaid |
$271.60
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$216.79
|
| Rate for Payer: Wellcare Medicare Advantage |
$330.78
|
|
|
INCISION OF TOE TENDON
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
HCPCS 28232
|
| Hospital Charge Code |
76100995
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.16 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Aetna Commercial |
$379.73
|
| Rate for Payer: Ambetter Exchange |
$228.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.16
|
| Rate for Payer: Anthem Medicaid |
$142.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$228.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$228.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$273.80
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$430.74
|
| Rate for Payer: Healthspan PPO |
$472.90
|
| Rate for Payer: Humana Medicaid |
$142.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$306.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$228.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$145.06
|
| Rate for Payer: Molina Healthcare Passport |
$142.22
|
| Rate for Payer: Multiplan PHCS |
$642.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$296.62
|
| Rate for Payer: UHCCP Medicaid |
$128.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$143.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$228.17
|
|
|
INCISION OF TOE TENDON
|
Facility
|
IP
|
$1,070.00
|
|
|
Service Code
|
HCPCS 28232
|
| Hospital Charge Code |
76100995
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$321.00 |
| Max. Negotiated Rate |
$1,027.20 |
| Rate for Payer: Aetna Commercial |
$823.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$834.60
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$888.10
|
| Rate for Payer: First Health Commercial |
$1,016.50
|
| Rate for Payer: Humana Commercial |
$909.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$877.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$789.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$941.60
|
| Rate for Payer: Ohio Health Group HMO |
$802.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$930.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$738.30
|
| Rate for Payer: PHCS Commercial |
$1,027.20
|
| Rate for Payer: United Healthcare All Payer |
$941.60
|
|
|
INCISION OF TOE TENDON
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
HCPCS 28232
|
| Hospital Charge Code |
76100995
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$367.97 |
| Max. Negotiated Rate |
$2,070.25 |
| Rate for Payer: Aetna Commercial |
$823.90
|
| Rate for Payer: Anthem Medicaid |
$367.97
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,478.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$834.60
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,070.25
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,996.31
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$888.10
|
| Rate for Payer: First Health Commercial |
$1,016.50
|
| Rate for Payer: Humana Commercial |
$909.50
|
| Rate for Payer: Humana KY Medicaid |
$367.97
|
| Rate for Payer: Humana Medicare Advantage |
$1,478.75
|
| Rate for Payer: Kentucky WC Medicaid |
$371.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$877.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$789.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,774.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$375.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$941.60
|
| Rate for Payer: Ohio Health Group HMO |
$802.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$930.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$738.30
|
| Rate for Payer: PHCS Commercial |
$1,027.20
|
| Rate for Payer: United Healthcare All Payer |
$941.60
|
|
|
INCISION OF TOE TENDON(P
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
HCPCS 28232
|
| Hospital Charge Code |
761P0995
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$122.16 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Aetna Commercial |
$379.73
|
| Rate for Payer: Ambetter Exchange |
$228.17
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$122.16
|
| Rate for Payer: Anthem Medicaid |
$142.22
|
| Rate for Payer: Buckeye Individual/Medicaid |
$228.17
|
| Rate for Payer: Buckeye Medicare Advantage |
$228.17
|
| Rate for Payer: CareSource Just4Me Medicare |
$273.80
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cash Price |
$535.00
|
| Rate for Payer: Cigna Commercial |
$430.74
|
| Rate for Payer: Healthspan PPO |
$472.90
|
| Rate for Payer: Humana Medicaid |
$142.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$306.31
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$228.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$228.17
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$145.06
|
| Rate for Payer: Molina Healthcare Passport |
$142.22
|
| Rate for Payer: Multiplan PHCS |
$642.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$296.62
|
| Rate for Payer: UHCCP Medicaid |
$128.27
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$143.64
|
| Rate for Payer: Wellcare Medicare Advantage |
$228.17
|
|
|
INCISION OF URETHRA
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 53020
|
| Hospital Charge Code |
76102116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.12 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$160.67
|
| Rate for Payer: Ambetter Exchange |
$91.09
|
| Rate for Payer: Anthem Medicaid |
$76.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$91.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$91.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.31
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$142.61
|
| Rate for Payer: Healthspan PPO |
$128.47
|
| Rate for Payer: Humana Medicaid |
$76.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$132.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$91.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.64
|
| Rate for Payer: Molina Healthcare Passport |
$76.12
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$118.42
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$91.09
|
|
|
INCISION OF URETHRA
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
HCPCS 53020
|
| Hospital Charge Code |
76102116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.17 |
| Max. Negotiated Rate |
$2,649.89 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem Medicaid |
$103.17
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,892.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$2,649.89
|
| Rate for Payer: CareSource Just4Me Medicare |
$2,555.25
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Humana KY Medicaid |
$103.17
|
| Rate for Payer: Humana Medicare Advantage |
$1,892.78
|
| Rate for Payer: Kentucky WC Medicaid |
$104.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$105.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
INCISION OF URETHRA
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
HCPCS 53020
|
| Hospital Charge Code |
76102116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$234.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$249.00
|
| Rate for Payer: First Health Commercial |
$285.00
|
| Rate for Payer: Humana Commercial |
$255.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$246.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$221.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$90.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$264.00
|
| Rate for Payer: Ohio Health Group HMO |
$225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$240.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$207.00
|
| Rate for Payer: PHCS Commercial |
$288.00
|
| Rate for Payer: United Healthcare All Payer |
$264.00
|
|
|
INCISION OF URETHRA(P
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 53020
|
| Hospital Charge Code |
761P2116
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$76.12 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$160.67
|
| Rate for Payer: Ambetter Exchange |
$91.09
|
| Rate for Payer: Anthem Medicaid |
$76.12
|
| Rate for Payer: Buckeye Individual/Medicaid |
$91.09
|
| Rate for Payer: Buckeye Medicare Advantage |
$91.09
|
| Rate for Payer: CareSource Just4Me Medicare |
$109.31
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cash Price |
$150.00
|
| Rate for Payer: Cigna Commercial |
$142.61
|
| Rate for Payer: Healthspan PPO |
$128.47
|
| Rate for Payer: Humana Medicaid |
$76.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$132.72
|
| Rate for Payer: Medical Mutual Of Ohio Medicare Advantage |
$91.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$91.09
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$77.64
|
| Rate for Payer: Molina Healthcare Passport |
$76.12
|
| Rate for Payer: Multiplan PHCS |
$180.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$118.42
|
| Rate for Payer: UHCCP Medicaid |
$105.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$76.88
|
| Rate for Payer: Wellcare Medicare Advantage |
$91.09
|
|
|
INCRUSE ELIPTA 30 DOSE INHALER
|
Facility
|
OP
|
$31.97
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$30.69 |
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Anthem Medicaid |
$10.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.94
|
| Rate for Payer: Cash Price |
$15.98
|
| Rate for Payer: Cigna Commercial |
$26.54
|
| Rate for Payer: First Health Commercial |
$30.37
|
| Rate for Payer: Humana Commercial |
$27.17
|
| Rate for Payer: Humana KY Medicaid |
$10.99
|
| Rate for Payer: Kentucky WC Medicaid |
$11.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$11.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.13
|
| Rate for Payer: Ohio Health Group HMO |
$23.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.06
|
| Rate for Payer: PHCS Commercial |
$30.69
|
| Rate for Payer: United Healthcare All Payer |
$28.13
|
|
|
INCRUSE ELIPTA 30 DOSE INHALER
|
Facility
|
IP
|
$31.97
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004295
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$30.69 |
| Rate for Payer: Aetna Commercial |
$24.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$24.94
|
| Rate for Payer: Cash Price |
$15.98
|
| Rate for Payer: Cigna Commercial |
$26.54
|
| Rate for Payer: First Health Commercial |
$30.37
|
| Rate for Payer: Humana Commercial |
$27.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$26.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$23.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$28.13
|
| Rate for Payer: Ohio Health Group HMO |
$23.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$25.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$27.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$22.06
|
| Rate for Payer: PHCS Commercial |
$30.69
|
| Rate for Payer: United Healthcare All Payer |
$28.13
|
|
|
INCRUSE ELIPTA 7 DOSE INHALER
|
Facility
|
IP
|
$44.29
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Aetna Commercial |
$34.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.55
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cigna Commercial |
$36.76
|
| Rate for Payer: First Health Commercial |
$42.08
|
| Rate for Payer: Humana Commercial |
$37.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.98
|
| Rate for Payer: Ohio Health Group HMO |
$33.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.56
|
| Rate for Payer: PHCS Commercial |
$42.52
|
| Rate for Payer: United Healthcare All Payer |
$38.98
|
|
|
INCRUSE ELIPTA 7 DOSE INHALER
|
Facility
|
OP
|
$44.29
|
|
|
Service Code
|
HCPCS J3535
|
| Hospital Charge Code |
25004294
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.29 |
| Max. Negotiated Rate |
$42.52 |
| Rate for Payer: Aetna Commercial |
$34.10
|
| Rate for Payer: Anthem Medicaid |
$15.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$34.55
|
| Rate for Payer: Cash Price |
$22.14
|
| Rate for Payer: Cigna Commercial |
$36.76
|
| Rate for Payer: First Health Commercial |
$42.08
|
| Rate for Payer: Humana Commercial |
$37.65
|
| Rate for Payer: Humana KY Medicaid |
$15.23
|
| Rate for Payer: Kentucky WC Medicaid |
$15.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$36.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$32.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$13.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$38.98
|
| Rate for Payer: Ohio Health Group HMO |
$33.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$35.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$38.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$30.56
|
| Rate for Payer: PHCS Commercial |
$42.52
|
| Rate for Payer: United Healthcare All Payer |
$38.98
|
|
|
INDERAL LA(PROPRANOL 60MG/1CAP
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 527411637
|
| Hospital Charge Code |
25000777
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem Medicaid |
$1.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Humana KY Medicaid |
$1.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
INDERAL LA(PROPRANOL 60MG/1CAP
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 527411637
|
| Hospital Charge Code |
25000777
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.22 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.43
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.65
|
| Rate for Payer: First Health Commercial |
$4.18
|
| Rate for Payer: Humana Commercial |
$3.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.87
|
| Rate for Payer: Ohio Health Group HMO |
$3.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Payer |
$3.87
|
|
|
INDERAL LA(PROPRANOL 80MG/1CAP
|
Facility
|
OP
|
$4.43
|
|
|
Service Code
|
NDC 527411737
|
| Hospital Charge Code |
25000778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
INDERAL LA(PROPRANOL 80MG/1CAP
|
Facility
|
IP
|
$4.43
|
|
|
Service Code
|
NDC 527411737
|
| Hospital Charge Code |
25000778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.46
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: First Health Commercial |
$4.21
|
| Rate for Payer: Humana Commercial |
$3.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.90
|
| Rate for Payer: Ohio Health Group HMO |
$3.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.06
|
| Rate for Payer: PHCS Commercial |
$4.25
|
| Rate for Payer: United Healthcare All Payer |
$3.90
|
|
|
INDERAL (PROPRANOLOL 10MG/1TAB
|
Facility
|
IP
|
$4.45
|
|
|
Service Code
|
NDC 60687058701
|
| Hospital Charge Code |
25000775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.07
|
| Rate for Payer: PHCS Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
INDERAL (PROPRANOLOL 10MG/1TAB
|
Facility
|
OP
|
$4.45
|
|
|
Service Code
|
NDC 60687058701
|
| Hospital Charge Code |
25000775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Anthem Medicaid |
$1.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.47
|
| Rate for Payer: Cash Price |
$2.22
|
| Rate for Payer: Cigna Commercial |
$3.69
|
| Rate for Payer: First Health Commercial |
$4.23
|
| Rate for Payer: Humana Commercial |
$3.78
|
| Rate for Payer: Humana KY Medicaid |
$1.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.92
|
| Rate for Payer: Ohio Health Group HMO |
$3.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.07
|
| Rate for Payer: PHCS Commercial |
$4.27
|
| Rate for Payer: United Healthcare All Payer |
$3.92
|
|
|
INDERAL (PROPRANOLOL) 1MG/1ML
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS J1800
|
| Hospital Charge Code |
25003121
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.35
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
|
INDERAL (PROPRANOLOL) 1MG/1ML
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS J1800
|
| Hospital Charge Code |
25003121
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.50 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$88.55
|
| Rate for Payer: Anthem Medicaid |
$39.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$89.70
|
| Rate for Payer: Cash Price |
$57.50
|
| Rate for Payer: Cigna Commercial |
$95.45
|
| Rate for Payer: First Health Commercial |
$109.25
|
| Rate for Payer: Humana Commercial |
$97.75
|
| Rate for Payer: Humana KY Medicaid |
$39.55
|
| Rate for Payer: Kentucky WC Medicaid |
$39.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$94.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$84.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$34.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$40.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$101.20
|
| Rate for Payer: Ohio Health Group HMO |
$86.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$92.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$100.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$79.35
|
| Rate for Payer: PHCS Commercial |
$110.40
|
| Rate for Payer: United Healthcare All Payer |
$101.20
|
|
